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General NPI Number Information
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NPI Number | 1417741844
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Entity Type | Individual
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Provider Name | KAMOLCHANOK DEER CHEUNG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1415 E STATE ST STE 800
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City | ROCKFORD
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State | IL
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Zip | 61104-2344
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Country | US
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Telephone | 779-696-9204
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Fax | 779-379-3774
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Provider Business Mailing Address
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Address Line | 15912 WOODDALE DR
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City | UNION
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State | IL
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Zip | 60180-9607
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Country | US
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Telephone | 331-425-3684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 051303239
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License Number State | IL
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